Pharmacy

Improving the Patient Experience

Out-of-Network Provider Appeal Process for Denied Claims

Date Issued: 7/25/2013

Out-of-network providers are permitted to file a standard appeal for a denied Medicare Advantage claim only if they complete a waiver of liability. This waiver states they will not bill the member regardless of the outcome of the appeal.

Appeals must be submitted within 60 calendar days of the date on the notice of the denial and include:

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